Specialising in musculoskeletal, orthopaedic, spinal and sports rehabilitation

New Year’s Resolutions 2024

It’s January and the new year brings about the reflection of new year’s resolutions.
This will no doubt involve some sort of new fitness regime
We all know the benefits of regular exercise, but what are the 5 most common mistakes that new comers and those returning to the gym make?

The correct dose of exercise – The Goldilocks principle
Consistency is key – You can’t get fit in one workout
Dynamic Warm up – Save static stretching until the end
Train Movements NOT Muscles – Train the brain
Having a plan to your training – Let your plan be your guide

The correct dose of exercise – The Goldilocks principle

Exercise Prescribers here at Marylebone Physiotherapy, we are experts at getting the dosage of exercise correct for each client. Not too easy as to be ineffective and not too hard as to not be able to walk the next day. Not too cold, not too hot, but just right, is also known as the Goldilocks principle. Exercise can be defined as physical movement that is:



Purposeful and


We can use the acronym RePPS to help us remember this

Repeating a movement is the very definition of exercise. You learn to master a particular movement, then you load it up with heavier weights or speed up the movement. You can also perform the movement under fatigue.

Planning your exercise is covered later on in this Blog.

Purposeful relates to your specific fitness goals. Remember that weight loss is a side effect of fitness training and not the desired goal.

Structured refers to the way your training session is broken down into its component parts

Below is an example of a typical gym session:

Dynamic Warm up
Metabolic conditioning
Cool Down
Use the RePPS principle for your next session.

Consistency is key – You can’t get fit in one workout

“You can’t drink the Ocean in one gulp!”

It is the same with exercise, you can’t get fit in one workout, just like you can’t live your life in one day.

The first six weeks of training you are unlikely to see any results. However, you are likely to feel better and have more energy. The best things come to those who wait, but in a society that wants instant gratification the wait can be frustrating.

Around 8 weeks the physical transformation becomes visible. We tend to lose body fat and gain lean muscle. Look forward to 12 weeks and things are looking even better

However, you will eventually plateau with your fitness gains and this is where you need to maintain it. Make time for exercise and be consistent.

Dynamic Warm up – save static stretching to the end

If you have not trained since your School, College or University days then things have changed. Wear warm layers and slowly strip them off as your body warms naturally with the heat generated from the movement.

We tend to favour a dynamic warm up in preference to static stretching. We can save that until the end of the workout. Because performing static stretches slows down your heart rate, lowers injury risk and helps reduce DOMS (Delayed Onset Muscle Soreness) we tend to leave it for after the workout. The other reason for this relates to studies where over stretching muscles in the warm up loses the protective effect of the tendon reflex that is designed to stop over stretching.

Dynamic as the name suggests means we are moving through a movement rather than holding a static posture. This could look like Squats and lunges or Press ups and toe touches. Starting with partial movements and building into full range, listening to the body and not pushing into pain or restriction.

Movement sequences that open the hips and rotate the body and examples of dynamic stretching.

Train Movements NOT Muscles – Train the Brain

Unless you are body building or focusing on particular muscles, then we at Marylebone Physiotherapy would encourage you to train movements not muscles. That’s why we have our own Movement Specialist, Katia.

Movement is a skill, and as such it needs to be practiced and challenged in order to not just make it better, but optimise the movement. The brain knows nothing of individual muscles, it knows only movement.

There are seven level 1 functional movements that you should be familiar with, these are:
Hinge or bend
Walking (Gait)

These seven movements form the basis of all functional movements the body has to perform.

Examples of Level 2 functional movements are running jumping and throwing.

Level 3 functional movements are the highest level and these require proficiency at levels 1 and 2 before attempting. Level 3 includes multi-directional movements or combinations of movements linked together.

An example of this is a Burpee.
This is a hip hinge into a press up, back into standing and then performing a jump at the top of the movement. The Burpee is normally completed at speed to add to the challenge of the movement.

Having a plan to your training – Let your plan be your guide

How do you get there if you don’t know where you’re going?

The answer is to have a plan. This will be based on your Fitness goals.

Are you doing a Couch to 5 km or Running a Marathon? Are you starting your first Boot-camp or competing at CrossFit?

Most Gym goers start with a “Push, Pull, Legs” Plan of three times a week

You could train one of the functional movements every day of the week. Or you could break the functional movements up into training each once during the week.

An example might be:

Monday – Push, Twist

Tuesday – Walk

Wednesday – Pull, Lunge

Thursday – Walk

Friday – Hinge, Squat

So, there you have it. The five most common Gym mistakes and how to avoid them happening to you.

Now it’s your turn to implement this new knowledge and have an injury free return to training.

This is your year to get fit, stay injury free and enjoy being healthy.

What is Electrical Muscle Stimulation?

Electrical Muscle Stimulation (EMS) is used at Marylebone Physiotherapy & Sports Medicine and this is a Blog about why and how we use it to help optimise your recovery after an injury.

EMS is a type of Electro-therapy which stimulates a muscle contraction using electrical impulses in order strengthen weak muscles, reduce swelling, relieve pain and help optimise tissue heal wound healing.

The impulses are generated by our COMPEX 8.0 device and are delivered through electrodes (pads that adhere to the skin) over the middle of the muscles that require stimulating.

The impulses from EMS mimic the action potential (stimulus required to make the muscle contract) coming from the central nervous system. This  causes the muscle to contract and bypasses the brain’s conscious control of muscle activation. This can feel a little unnerving the first time you have muscle stimulation.

EMS therapy creates steady electric impulses that stimulate muscle contractions–many of them over a sustained therapy session.

This repetitive contracting and relaxing of the muscle has the beneficial effects of:

  • Increasing circulation (blood flow) to the affected tissue area, which aids in repair.
  • improving strength by flexing and working weakened muscles.
  • slowing the process of muscle atrophy by strengthening weakened or unused muscles.
  • adapting, training and “educating” the mind-muscle connection and muscle fibers to certain patterns of response (e.g., contracts the fibers that are responsible for force, which results in building strength).

There are several uses for EMS which include:

Pain relief.
EMS can be used at low levels to reduce the amount of pain you experience. This can be done by modulating the amount of pain signals to the brain or releasing natural pain-killers called endorphins.

Muscle contraction.
EMS can be used at different intensities to stimulate a muscle or help maintain muscle tone. Examples of this type of therapy include:
Following a stroke, EMS can be used to maintain some muscle tone in the shoulder to improve function and reduce pain.
To treat urinary incontinence, EMS may be used to contract the pelvic floor muscles.

Following surgery

EMS can be used to stimulate the muscles in the thigh to increase strength.

Benefits of EMS include:

  • Decreasing pain
  • Promote tissue healing
  • Increase muscle strength
  • Maintaining and regaining muscle activity – particularly post surgerical or post injury

Here are some examples of this

If you’ve torn an Achilles tendon, the muscles in your calf and foot may become atrophied from wearing a boot to immobilize the ankle, or from changing your gait to favor the injured ankle.

If you have a shoulder injury (e.g., a rotator cuff tear or impingement), resting, immobilizing, or favoring the shoulder may cause the muscles in and around that shoulder to weaken.

If you have neuromuscular dysfunction or a neuromuscular disorder (such as muscular dystrophy), muscles throughout the body may weaken progressively; EMS can help to slow this progression and improve motor control.


If you have never had EMS before what can you expect?

The first time you have EMS you will be surprised at how bizarre the experience is, as your muscles will start to tingle, then shake without your conscious control it can be a little bit daunting.

The first time EMS contracts your muscles using the Resistance or Strength Protocol this is even stranger as the Physio in charge of your care slowly gets you used to having your muscles contracted externally. It begins with a low buzzing sensation followed by the muscle actually contracting, then cycling with a tapping sensation. As you get more used to the experience, the muscle activation can be slowly increased and the cramping sensation is avoided 

The next phase is to perform movement with the Muscle Contraction. This could be a knee extension in sitting to stimulate the Quadriceps. Or, this might be a Squat where you have to overcome the resistance of the muscle contraction.

Your Physio can use the EMS in any number of ways depending on your unique treatment goals.

So, there you have it. Marylebone Physiotherapy and Sports Medicine remains up to date with the latest technology and cutting edge devices to take you from pain to performance.

Book YOUR appointment today.

How to survive a festival

The Festival season is upon us and the team have just got back from a few Festivals already!

It got us thinking that Festivals can by dangerous places, particularly if you are going in the mosh pit!

But just standing around and watching bands can give you back pain, leg pain, calf problems, knee pain and neck pain, all these can be due to a number of different factors, from sleeping positions to lifting heavy people who want to crowd surf.

The good news is that there are ways you can improve your chances of having an injury and pain free Festival.

1. Prepare to move or Mosh!

If you have a desk based job or live a sedentary lifestyle, being at a festival for four days can be a sudden, huge increase in activity and shock for your body. Out of interest I checked the health app on my phone after Download this year and I totalled around 90k or 56 miles by the end of the weekend. You wouldn’t go on a three day 56 mile hike without any training, preparation or proper footwear, so it’s crazy when you think that we just turn up in wellies and shorts and do that for a full weekend. I’m not suggesting that you start training for a festival, but obviously being as active, strong and healthy as you can beforehand is going to work in your favour.You also need to be realistic and prepare if you have an injury or pre-existing condition.

2. Wear sensible footwear

Wellies are heavy and clumpy, which can cause you to move around differently and affect the biomechanics of how your body functions as a whole.Hiking boots (if it’s wet) or a good pair of trainers (if it’s sunny) are better options as they’re much more supportive and are going to help to take the impact of all that walking. Obviously, if it’s torrential downpour then you may want to switch between wellies and hiking boots to give them a chance to dry off.

3. Invest in sleeping equipment

It’s not always easy to sleep at festivals, but sleep gives your muscles a much needed chance to relax whilst your body works to repair and heal itself.
If you’re on a really hard surface, you’re going to be waking up throughout the night and moving into uncomfortable positions. Invest in making your sleeping area more comfortable if you can. This could be something like a decent inflatable roll-matt or a more expensive option like an airbed.

4. Stay hydrated

Drink some water with your alcohol!
If you become dehydrated your body’s tissues are more susceptible to injury. Make sure that you drink enough WATER throughout the festival and especially if you are in the sun all day and drinking alcohol.

5. Find the Massage Tent ASAP

Many festivals offer massage. If you can find the time or wake up early enough, then taking part in these can be a great way to rest and recuperate after a night of partying.

6. Lift carefully

Transporting heavy equipment, carrying a rucksack and even lifting others onto your shoulders can easily leave you injured or in discomfort.Be mindful of how you are lifting and carrying things, and don’t overload yourself. Think about how you’re going to shift your equipment to and from your car and campsite. If it feels like too much, then two trips are going to be better than one. Trollies can also be helpful.

7. Prepare if you have an existing issue or injury

If you’re recovering from an old injury or know that you have a pre-existing issue, for example a weakness in your ankle, then think about how you are going to manage this beforehand.If you see a physiotherapist in advance they will be able to offer you advice about building strength in the area where you will need it and how to manage your issue once there.It can also help to plan for a flare-up, for example by packing compression bandages and pain medication with the advice of your doctor or pharmacist.

8. Stretch to relieve tension

These are great stretches that can help to relieve common areas of tension either while you are at the festival or once you get home.

9. Rest after the festival

Once you get home make time to rest and get a good night’s sleep.Putting your feet up can help to relieve tension in your legs and feet.Many people also use ice and heat to relieve aches and pains, for example in the neck and back.

10. Plan for disaster

Drunk people tend to fall over and tents don’t offer a lot of support so when the 2 meet poles tend to get broken so take some Gaffa tape with you to try and patch up any broken poles.

11. Enjoy yourself

Lets remember your there to enjoy yourself so do just that, drink lots, meet new friends and party like a Rock Star!

12. Don’t ignore an injury or pain that doesn’t subside.

All festivals will have paramedics on hand and a medical tent.
If you are concerned that you have sustained an injury or if you are struggling to move, you should rest the area and seek help from them.
The majority of what we call acute soft-tissue injuries, which includes sprains and strains, will feel better within a few days and recover within 4 weeks with the right care and rest.

If it has been more than a week since the festival and you are still experiencing pain or the problem isn’t getting better, then see a Physiotherapist. They will be able to identify the underlying cause, accelerate your recovery and provide you with relief from pain by using manual therapies such as soft-tissue massage.

George is Back!

George is back!

George is our clinical specialist here at Marylebone Physiotherapy and Sports Medicine and he has just returned from travelling in Central America.

We often struggle to maintain good health practices when travelling, particularly in planes, trains and automobiles. We might be in hotels or bed & breakfast places that do not have a Gym or an open space in which to exercise.

So how did George maintain his Fitness whilst travelling?

George’s top 5 tips for travelling and staying healthy:

  1. Get up and move! – whether on planes, trains or automobiles the key is movement to avoid becoming chair-shaped
  2. Strength Exercises (when on the go) – Maintain your gains
  3. Movement practice – Think Movement NOT Muscles
  4. Plan & Prepare For Your Activity – From Sedentary to Athletic 
  5. Fitness Testing on the Move – If you’re not assessing you’re guessing

Get up and move!:

The body is not meant to be in static positrons for longer than 30 minutes, so armed with this knowledge, George made sure to get up and move every 30 minutes in order to break the sitting habit and avoid tired, achy muscles.

Strength Exercises (when on the go) – Maintain your gains

In order to maintain his strength whilst travelling George used a series of simple but effective “Muscle Maintainers”

  • Pyramid Press Ups 

George performed this by Doing 1 Press up, then holding at the top of the movement for 1 second, (in order to challenge his stability) and this progressed to 2 press ups with a 2 second hold and so on. George normally gets up to 10 reps before he finds it challenging.

Movement Practice 

When you’re on holiday you can go from lying on the beach to doing athletic activities like Surfing in a short space of time.

If you know you are going to do an activity later in the day then its worth practicing the movement a couple of times so you don’t have to go from zero to hero too quickly.

George would practice, “Popping up” on his Surf board on the beach before going into the water. This can also be performed as an exercise that is suitably named, “Surfers”

To perform a Surfer, you do a burpee, but rather than come up into the Squat position, you jump up as if on a Surfboard at a side angle, make sure to do both left and right sides.

Plan & Prepare For Your Activity 

When George would go Surfing he made sure that he warmed up his body before the event. He analysed the task of Surfing and broke the movements down into their component parts.

The swimming, Popping up on the board and riding the waves.

Swimming requires upper body strength and endurance, especially of the shoulders, so, some simple arm circles and activation of the rotator cuff are a good idea before you hit the water and paddle like mad to catch that wave.

Fitness Testing on the Move

The Static Wall Sit is not only a great way of maintaining Quadriceps Strength/Endurance, but it is also a great physical test.

George would test himself by simply sitting against a wall with his knees at 90 degrees. He always aimed for 2 minutes which is quite the Quads burn!

The Plank is always a favourite for mid-line stabilisation. George would normally hold the Plank for 2 minutes.

How many Press Ups can you do in a minute?

This is a great test of upper body endurance.

About George

George is our resident expert for using objective markers to demonstrate success in his treatments. He is a results-driven Physiotherapist

His three tenants are Communication, Manual Therapy & Exercise.

George’s favourite is the VALD suite of measures. These consist of Force Platforms, Blood-Flow Restriction and Pressure Dyno-monitory.

If you would like to know more about how the VALD Products work book in with George at Marylebone or East London Physiotherapy & Sports Medicine

Marylebone Physiotherapist, Alexia Critien, Health Consultants Inc, London, Best Physiotherapist, Musculoskeletal treatment, Acupuncture, Massage, Clinical Pilates, Anti-gravity physiotherapy, Baker Street, Gloucester Place, BNP Paribas, Costa Coffee, Pret a Manger, The Dorset Cafe, Oxford Street, Marylebone train station,

Gyrotonic Stabilisation

I’ve always been slightly daunted about write about Gyrotonic in the newsletter mainly because it is such a complex and sophisticated system that at times you don’t know where to start or end. Gyrotonic for me is like a great movie or a fantastic painting or a trip to a favourite holiday destination – every time you visit it you discover something new. And just when you think you’ve nailed it, it offers up another dimension

So, where to start? Let’s start with a common misconception – it’s all about moving the body. For a balanced functional body we need strength, mobility, flexibility and endurance.  One cannot exist without the other and when this balance is disrupted we often have dysfunction and suffer pain and injury. So any modality worth its salt will incorporate all these factors.

Yoga, Martial Arts, Pilates – and many more encompass these factors. With this laid down it wouldn’t make for a great discipline for Gyrotonic to only focus on movement. For fantastic movement you need to be mobile – that is your moving parts or joints need to have good range. Above and beyond this the structures around these parts need to be flexible to allow the range of movement and the strength to hold them well in place. And without endurance in the body the movement cannot be sustained in quality or quantity.

Gyrotonic’s foundation is in stabilization not movement, moreover dynamic stabilization.  This is widely referred to within Gyrotonic and Gyrokinesis as Narrowing.  Narrowing encompasses focal areas essential for stability but in such a way it becomes organic in nature.  What do I mean by organic? Techniques are taught to encourage activation of deep stabilizing muscles, with the least amount of energy to create a balanced stable and open body.   This ability creates a feeling of not only strength but a lightness and length.

So now you have the magic every body needs for a great foundation – now you can move!  And then it is all about the movement and what great movement it is.  Organic movement and organic quality of movement.  What do I mean by organic movement?  Ahhh you have to wait for the next article on Gyrotonic – unless another dimension gets in the way!

Diagnostic Ultrasound

Diagnostic Ultrasound is a very valuable clinical tool in assessing soft tissue pathology. Diagnostic ultrasound involves the use of a scanner to send soundwaves into the tissue. They bounce back a signal from the tissues to create an image of the underlying tissue. We use diagnostic ultrasound in the clinic to help assess tendon and soft tissue pathology. It allows us to be more specific in our diagnosis and know when to refer or how to best rehabilitate the injured region.

It is an excellent tool for assessing shoulder pathology and helping to identify underlying rotator cuff pathology or a bursitis. We also use the ultrasound to assess other tendon pathology within the body. Commonly scanned tendons include the Achilles and patella tendon.

Diagnostic ultrasound can also be used in teaching deeper abdominal activation which is imperative to having a happy healthy lumbar spine.

Marylebone Physiotherapist, Alexia Critien, Health Consultants Inc, London, Best Physiotherapist, Musculoskeletal treatment, Acupuncture, Massage, Clinical Pilates, Anti-gravity physiotherapy, Baker Street, Gloucester Place, BNP Paribas, Costa Coffee, Pret a Manger, The Dorset Cafe, Oxford Street, Marylebone train station,

Pilates Principles: Centering

Centering is an important concept in pilates. It comprises of finding your neutral spine and activating your deep tummy muscles to keep your spine in a safe stable position to allow you to move your arms and legs more efficiently. Neutral spine is different for everybody, as it depends on your individual spinal curves. Ideally you should have a small curve in the lower back. To find it you tilt your pelvis back and forth until you find the mid-point of the available range.

Your deep tummy muscles (transversus abdominis) are the only core muscles to attach directly to the spine via some fascia (tough connective tissue). It is thought that in people with back pain, the activation of this muscle is delayed. To activate this muscle imagine that you are drawing in your lower tummy, as if you are trying to squeeze into a tight pair of jeans.

By having a solid centre, you will be able to transmit force and movement through your limbs more effectively